Non-suicidal self-injury (NSSI) in adolescents is a common clinical condition among young people, often associated with adolescent depression or bipolar disorder. The clinical diagnosis and treatment remain challending, leading to issues such as diagnostic inconsistency and poor therapeutic outcomes. We invited a panel of Chinese experts from the fields of psychiatry, clinical psychology, traditional Chinese medicine (TCM) for emotional disorders, integrated traditional Chinese and Western medicine, and evidence-based medicine. Based on clinical practice, particularly in relation to adolescent depression and bipolar disorder, we have developed a clinical pathway for the integrated management of adolescent NSSI in China. Guided by principles of practicality, scientific validity, cost-effectiveness, and ease of memorization, this clinical pathway is named “DIARY.” It offers a constructive approach for the comprehensive, in-depth, and effective treatment of adolescent NSSI. This is the first clinical pathway for NSSI, and it is a combination of traditional Chinese and Western medicine. There may be shortcomings, but it provides a foundation for developing more comprehensive clinical pathway in treatments for NSSI in the future.

Background Early detection of Alzheimer's disease (AD) is critical for timely intervention. Subjective cognitive decline (SCD), defined as self-perceived cognitive worsening while objective performance on standardized tests remains normal, when accompanied by neurodegenerative changes on brain imaging (e.g., hippocampal atrophy), can be classified as SCD with neurodegeneration of AD form (SCD-NDAD). This phenotype may represent an early stage of AD. Objective Investigate the prevalence and clinical characteristics of SCD-NDAD in general population. Methods: This multicenter, community-based cross-sectional study was conducted from 2013 to 2019 across 31 communities in eight major cities of northern, eastern, southern, and western China. Community-dwelling adults aged 50 years and older were recruited through cluster sampling. Participants underwent standardized interviews, neuropsychological assessments, and magnetic resonance imaging, on the basis of which SCD-NDAD was identified. The prevalence of SCD-NDAD was estimated with age- and sex-standardized weights. Results Of 5054 participants (mean age 69.4 years, 60.6% women), 2886 completed MRI. In participants aged ≥50 years, the prevalence of SCD-NDAD was 4.9% (95% confidence interval: 4.1% to 5.8%). In participants aged 65 years and older, prevalence increased to 6.5% (95% confidence interval: 5.5% to 7.7%). While these individuals exhibited preserved cognitive function across all domains, they demonstrated significant hippocampal atrophy, a key marker of AD-related neurodegeneration. Conclusions SCD-NDAD is common among older adults in China, with an estimated prevalence affecting 12.4 million individuals aged ≥65 years. Identifying this cohort may offer a critical window for early intervention and holds significant implications for public health strategies aimed at dementia prevention.

Hypomania, a diagnostic phase of bipolar disorder (BD), has garnered considerable research attention regarding its underlying neurobiological mechanisms, which remain inadequately understood. This cross-sectional observational study aimed to investigate the neurobiological correlates of hypomania by examining local brain activity and functional connectivity (FC) through resting-state functional magnetic resonance imaging (rs-fMRI) analyses. The results revealed abnormal local brain activity in the anterior orbital gyrus (OFCant) and superior frontal gyrus (SFG) in patients with hypomania. Additionally, FC analysis demonstrated disrupted connectivity between the right OFCant (R OFCant) and both the right putamen (R PUT) and right insula (R INS). Notably, these altered connectivity patterns showed significant correlations with clinical symptom severity. Collectively, these findings provide preliminary neuroimaging evidence for the neurobiological basis of hypomania, warranting replication and validation in larger and independent cohorts.

Cognitive deficits are a hallmark of Alzheimer’s disease (AD), and effective treatments remain elusive. Transcranial alternating current stimulation (tACS), a non-invasive technique, has shown potential in improving cognitive function across various populations, but further research is needed to investigate its efficacy in AD. In a randomized, double-blind, sham-controlled pilot trial, 36 mild AD patients received active or sham theta-tACS (8 Hz, 1.6 mA, 20-min daily) during n-back task for two weeks, followed by a 10-week follow-up. Cognitive assessments and resting-state EEG were analyzed at baseline, after-treatment, and follow-up. The results showed that the active group demonstrated significant cognitive improvements after treatment (MMSE: t (15) =-3.273, p = 0.005, Cohen’s d = 0.82), particularly in short-term memory (MMSE-recall: Z = -2.11, p = 0.035, r = 0.53), with maintained benefits after 10 weeks. In contrast, the sham group exhibited long-term cognitive decline (MMSE: t (4) = 3.586, p = 0.023, Cohen’s d = -1.60). EEG analysis revealed reduced gamma power (t (23) = 2.689, p = 0.013, Cohen’s d = 1.077) and theta connectivity in active group, particularly in the frontotemporal regions (F4/F7: t (23) = 2.467, p = 0.021, Cohen’s d = 0.988; F4/T3: t (23) = 2.465, p = 0.022, Cohen’s d = 0.987), which was correlated with cognitive improvements (R = –0.57, p = 0.043). In conclusion, tACS combining cognitive training may offer cognitive benefits in mild AD by modulating neural activity, though further studies are needed to clarify its mechanisms.

BACKGROUND:Physical frailty, characterized by heightened sensitivity to stressors and decreased physiological reserves, is an established risk factor for incident dementia among older adults. However, the biological mechanisms underlying this association remain incompletely elucidated. This study aimed to dissect the potential roles of systemic inflammation, metabolic dysregulation, and accelerated brain aging in the association between physical frailty and dementia. METHODS:This study included 452,516 participants from the UK Biobank who were free of dementia at baseline and had data available for all five components of frailty, with the majority also providing inflammatory, metabolic, neuroimaging and genetic information. Cox proportional hazard models were utilized to examine the longitudinal association between frailty and dementia. Causal mediation analyses were performed to quantify the potential mediating effects of composite scores for inflammation and metabolism, as well as accelerated brain aging (quantified as the brain age gap) on the observed frailty-dementia association. RESULTS:Over an average follow-up period of 13.7 years, 7,777 individuals were diagnosed with dementia. Compared to non-frail individuals, frailty status was significantly associated with an increased dementia risk (adjusted hazard ratio 2.21; 95% confidence interval 2.02-2.42), with an interaction effect between frailty and polygenetic risk score (P-value = 0.033). Inflammation and metabolic composite scores were separately constructed using weighted combinations of relevant biomarkers. Mediation analyses revealed that the inflammatory score and metabolic score significantly mediated 4% and 13% of the frailty-dementia association, respectively. Moreover, accelerated brain aging, estimated using machine learning applied to neuroimaging data, mediated a substantial proportion (20%) of the association between frailty and dementia. CONCLUSION:The positive association between frailty and dementia is mediated through multiple biological mechanisms pathways, including inflammation, metabolic dysregulation, and accelerated brain aging. These findings underscore the importance of frailty-oriented preventive strategies against dementia.

BackgroundAnti-amyloid disease-modifying therapies (DMTs) for early Alzheimer's disease (AD) are entering routine care, increasing the need for harmonized, registry-ready real-world data. The International Registry for Alzheimer's Disease and Other Dementias (InRAD) proposed a minimum dataset (MDS) and extended dataset (EDS), but their applicability to psychiatry-led old age mental healthcare practices in China is uncertain.ObjectiveTo adapt the InRAD dataset for real-world AD DMT practice across multiple psychiatry institutions in China and assess the feasibility of routine data capture for the proposed MDS/EDS.MethodsWe conducted a modified Delphi consensus study and a multicenter feasibility survey. Forty-nine experts classified domains/items into the MDS or EDS using predefined agreement thresholds. Thirty-five DMT-initiating mental healthcare teams reported the routine availability of the proposed data elements.ResultsHighly consistent with InRAD, ten domains were included in the China-adapted MDS/EDS, covering patient profiles and lifestyle, diagnostic work-up and biomarkers, treatment, outcomes, safety, treatment-monitoring examinations, and registry discontinuation. However, item prioritization reflected local practice, emphasizing diagnostic traceability, functional and neuropsychiatric outcomes, caregiver burden, and structured safety capture. Feasibility results revealed that many MDS elements were collected, but the consensus-defined MDS exceeded what is currently captured in a standardized, analysis-ready format; most EDS items were moderately feasible, while WHO-5 (patient version) and DAT-scan were least feasible.ConclusionsAn InRAD-aligned dataset is broadly acceptable for psychiatry-led AD DMT practices in China, but implementation gaps remain. A phased registry approach with standardized definitions and workflow-supported capture may improve the completeness and comparability of real-world DMT evidence.

STUDY OBJECTIVES:This study investigated the associations between changes in sleep dimensions, cognitive transition, and incident dementia. METHODS:Using data from the UK Biobank (UKB) and the China Health and Retirement Longitudinal Study (CHARLS), we systematically investigated longitudinal changes in eight distinct sleep dimensions, including sleep duration, chronotype, and napping, etc. Cognitive transitions were assessed through changes in standardized cognitive test scores in the UKB and categorized cognitive states (normal cognition, mild cognitive impairment [MCI], and probable dementia) in CHARLS. We used generalized linear models for cognitive scores, logistic regression for cognitive status transitions, and Cox models for dementia risk associated with changes in sleep dimensions. RESULTS:A total of 8994 and 14 720 participants were involved in the change-to-change analyses and change-to-dementia analyses, respectively. Compared to individuals who maintained their original sleep dimensions, those who changed their sleep duration to the optimal range (7-8 h/day) or shifted chronotype to morningness exhibited higher overall cognitive scores (β = 0.15, p = .037; β = 0.23, p = .011). Conversely, transitioning to non-optimal sleep duration (OR = 1.07, p = .034) or declining overall sleep quality (OR = 1.06, p = .006) increased the risk of cognitive decline from normal baseline. Napping cessation increased the risk of MCI progression to dementia (OR = 1.16, p = .001). Transitioning to non-optimal sleep duration (HR = 1.82, p = .005) and discontinuing napping (HR = 2.13, p = .015) were associated with a higher incident of all-cause dementia. CONCLUSIONS:Maintaining optimal or optimizing sleep duration, preserving napping habits, and transitioning to a morning chronotype are essential for dementia prevention.

BACKGROUND&AIMS:In 2019, the EAT-Lancet Commission proposed a predominantly plant-based diet aimed at enhancing human health and supporting environmental sustainability. However, its relationship with sleep apnea has not been extensively studied. This study aimed to investigate the association between adherence to the EAT-Lancet diet and the risk of developing sleep apnea. METHODS:The analysis included 200,373 participants from the UK Biobank. Dietary intake was assessed according to a modified diet history approach, and an EAT-Lancet diet index (scored 0-42 points) was calculated. Cox proportional hazards regression models were conducted to investigate the relationship between the EAT-Lancet diet and the risk of sleep apnea, while causal mediation analyses were used to assess the mediating role of BMI in this association. RESULTS:Over a mean 11.6 years follow-up, 2924 cases of sleep apnea (17.1%) were recorded. Participants with the highest adherence to the EAT-Lancet diet had an 18% lower risk of sleep apnea (95% CI: 6%-28%) compared to those with the lowest adherence (P < 0.05). Furthermore, the relationship between the EAT-Lancet diet and sleep apnea risk was 26.4% (95% CI: 13.6%-44.8%) mediated by BMI. CONCLUSION:These findings indicate that higher adherence to the EAT-Lancet diet is associated with a lower risk of developing sleep apnea, with BMI partially mediating this association.

BACKGROUND:With the advancement of anti-amyloid treatments for Alzheimer disease, accurate assays for amyloid-β (Aβ) pathology are essential. Plasma phosphorylated tau 217 (p-tau217) is a blood-based biomarker, but its performance varies across platforms, necessitating head-to-head comparisons. METHODS:This multicenter study evaluated 9 plasma p-tau217 assays (6 including Aβ42 measurements) for detecting amyloid positron emission tomography (PET) positivity. The final analysis included 431 participants from 10 memory clinics in China (median age, 68.0 years; 61.7% women; 64.0% amyloid PET-positive): 30 cognitively unimpaired individuals, 230 with mild cognitive impairment, and 171 with dementia. All plasma samples underwent blinded, batch-matched testing in a central laboratory across chemiluminescence immunoassay (Fujirebio, Beckman, Vazyme, manufacturer A), single-molecule immunoassay (Quanterix, Lychix, iomicsBio, manufacturer B), and multiplex bead-based flow cytometric immunoassay (CellGene). RESULTS:Seven of the 9 assays showed acceptable performance (area under the curve [AUC] 0.899-0.930), whereas 2 showed lower performance (AUC <0.800; P < 0.001). Under a two-cutoff approach (90% sensitivity/90% specificity), these 7 high-performing assays yielded an intermediate zone of 2.8% to 13.7%. Performance remained robust in mild cognitive impairment and dementia subgroups. Adding Aβ42 showed assay- and population-dependent effects. Manufacturer-recommended and previously published cutoffs showed variable performance in this independent cohort. CONCLUSIONS:Several plasma p-tau217 assays demonstrated strong diagnostic accuracy for amyloid PET positivity in this cross-sectional memory-clinic cohort, although performance varied across platforms and cutoff transferability was limited. Further longitudinal studies with predefined clinical outcomes are needed to determine prognostic value and clinical utility.

Schizophrenia (SCZ) is hypothesized to arise from neural circuit dysfunction, but the role of non-neuronal cells remains poorly defined. While astrocytic connexin 43 (Cx43) facilitates both gap junction (GJ) coupling and hemichannel (HC)-mediated gliotransmitter release, its specific role in SCZ remains unclear. Here, we report elevated Cx43 expression in the prefrontal cortex of individuals with SCZ and investigate its functional relevance in an MK801-induced mouse model. In this model, medial prefrontal cortex (mPFC) Cx43 upregulation was associated with enhanced HC activity without affecting GJ coupling. Pharmacological blockade of Cx43 HC with TAT-Gap19 rescued SCZ-like behavioral and synaptic alterations, whereas astrocyte-specific Cx43 overexpression (Cx43 OE) in the mPFC of naive mice recapitulated behavioral abnormalities. Mechanistically, increased HC activity was linked to excessive astrocytic glutamate release, which was directly visualized using ex vivo two-photon imaging with an astrocyte-specific glutamate sensor and normalized by TAT-Gap19. Together, our results integrate human expression data with experimental evidence to implicate astrocytic Cx43 HC dysregulation in prefrontal circuit dysfunction relevant to SCZ and suggest that glial HC signaling warrants further investigation in SCZ pathophysiology.

Background Psychiatric inpatients in China may experience threats to dignity and self-expression within ward environments shaped by stigma, safety concerns, and institutional routines. However, how they navigate these challenges and restore dignity through everyday interactions during hospitalization remains underexplored in psychiatric nursing. Aim To develop a substantive theoretical framework explaining how Chinese psychiatric inpatients experience dignity challenges and navigate pathways toward dignity empowerment and restoration during hospitalization, and what role therapeutic relationships with mental health nurses play in facilitating this process. Research design Constructivist grounded theory following the Charmaz tradition, informed by relational autonomy theory. Participants and research context 11 psychiatric inpatients were recruited from the psychiatric ward of a tertiary general hospital in China between March and June 2025, using maximum variation purposive sampling to ensure demographic diversity. Ethical considerations Ethical approval was obtained from the Ethics Committee of Sir Run Run Shaw Hospital, Zhejiang University School of Medicine (Reference 2025-2245-01). Findings The theoretical model “Finding Voice in Vulnerability” suggests that psychiatric inpatients may navigate dignity challenges through four interconnected relational processes: Cognitive Liberation and Conceptual Reconstruction, Relational Dignity Empowerment, Relational Reconstruction of Valued Identity, and Participatory Treatment Negotiation. The model further suggests that vulnerability may become a relational resource through dignity-affirming interactions that support autonomy and participation in treatment decisions. Conclusions Dignity empowerment may emerge through relational recognition rather than individual autonomy, suggesting a potential reorientation toward relationally informed psychiatric care. The findings suggest that everyday nursing interactions may be important contexts for empowerment, with implications for relational competency training and future longitudinal research across diverse psychiatric settings.

We report a case of leukocytoclastic vasculitis (LCV) in a 74-year-old woman, occurring seven months after the initiation of fluoxetine therapy for generalized anxiety disorder (GAD). The cutaneous lesions resolved upon discontinuation of fluoxetine but recurred promptly upon rechallenge. Notably, subsequent exposure to paroxetine, another selective serotonin reuptake inhibitor (SSRI) previously tolerated by the patient, also elicited a similar but less severe rash, suggesting cross-sensitization. Transition to venlafaxine, a serotonin-norepinephrine reuptake inhibitor (SNRI), led to complete and sustained resolution of the skin lesions. This case highlights three key clinical points: the potential for delayed-onset cutaneous adverse reactions to SSRIs even after months of uneventful treatment; the occurrence of cross-reactive hypersensitivity among SSRIs; and the importance of considering alternative antidepressant classes with distinct pharmacological profiles in patients with SSRI-associated vasculitis.

Introduction The clinical management of Alzheimer’s disease (AD) is still constrained by the fact that its incompletely understood pathogenesis, difficulty in early diagnosis and the limited long-term treatment benefits so far. This article summarizes a regional perspective on the diagnosis and treatment of AD from the Alzheimer’s Disease Chinese (ADC) guideline working group, aiming to improve the whole-process management of AD.Discussion The article presents a comprehensive overview of a proposed diagnostic and therapeutic paradigm for AD, consisting of a three-dimensional diagnostic framework and a sequential therapy concept. Crucially, while biological biomarkers of AD are present at all stages, they may be unrelated to clinical severity. To address this, the diagnostic framework combines core clinical criteria with early-changing biomarkers, syndrome staging and traditional Chinese medicine (TCM)-based pattern phenotyping. This integrated, simplified and practical approach enhances diagnostic certainty and its correlation with clinical severity. This sequential therapy is a stage-adaptive treatment plan adjusted according to the disease progression, utilizing a dynamic, multi-target combination therapy. Unlike the existing unchanging single-target therapies, this approach provides specific mechanistic interventions tailored to each stage to prolong efficacy and delay disease progression.Conclusions This paradigm provides a whole-process, stage-oriented approach to AD diagnosis and management that may improve translational relevance, clinical applicability and continuity of care in real-world settings. Future cohort-based validation studies are needed to confirm its diagnostic performance and clinical benefits, and to refine its implementation.

Clinical observation has identified cerebellar cognitive affective syndrome, which is characterized by various non-motor dysfunctions such as social disorders and anxiety. Increasing evidence has revealed reciprocal mono-/poly-synaptic connections of cerebello-cerebral circuits, forming the concept of the cerebellar connectome. In this study, we demonstrate that neurons in the cerebellar nuclei (CN) of male mice project to a subset of zona incerta (ZI) neurons through long-range glutamatergic and GABAergic transmissions, both capable of encoding acute stress. Furthermore, activating or inhibiting glutamatergic and GABAergic transmissions in the CN → ZI pathway can positively or negatively regulate anxiety and place preference through presynaptic plasticity-dependent mechanisms, as well as mediate motor-induced alleviation of anxiety. Our data support the close relationship between the cerebellum and emotional processes and suggest that targeting cerebellar outputs may be an effective approach for treating anxiety.

BACKGROUND:The relationship between serum and urine biomarkers with vascular dementia (VD) has been increasingly highlighted by observational studies. Yet, the causal nature underlying these associations remains elusive. OBJECTIVE:This research seeks to elucidate the causal relationships between 35 prevalent serum and urine biomarkers and the risk of VD onset through Mendelian randomization methods. METHODS:This study employs bidirectional Mendelian randomization, incorporating both forward and reverse approaches, to examine these potential causal links. The findings from the Mendelian randomization are further analyzed for pleiotropy, heterogeneity, and sensitivity to ensure robustness. RESULTS:The analysis through forward Mendelian randomization reveals that elevated levels of aspartate aminotransferase (AST) and triglycerides (TG) are linked to an elevated risk of developing VD, whereas higher levels of direct bilirubin (DBil) appear to mitigate this risk. These outcomes are corroborated by subsequent analyses for pleiotropy, heterogeneity, and sensitivity. On the other hand, reverse Mendelian randomization indicates that VD does not causally influence the levels of the 35 examined serum and urine biomarkers. CONCLUSION:The outcomes of this Mendelian randomization study affirm the causal influence of biomarkers AST, TG, and DBil on the progression of VD. These insights pave the way for leveraging AST, TG, and DBil as biochemical indicators for the forecasting, screening, and early diagnosis of VD, offering avenues for targeted interventions and management.

Major depressive disorder (MDD) and bipolar disorder (BD) are often misdiagnosed during depressive episodes, therefore, exploring biomarkers for differential diagnosis is important. Objective To identify circadian biomarker signatures in patients peripheral blood that differentiate MDD from BD during depressive states. Design, setting, and participants This case-control study recruited patients with MDD and BD at depressive state diagnosed by the Diagnostic and Statistical Manual of Mental Disorders Fifth Edition (DSM-5) and Health control (HC) subjects from January 2021 to May 2023. We collected serum samples to detect levels of Period (PER)1/PER2/phosphorylated cAMP reaction element binding protein (pCREB). Main outcomes and measures Participant clinical data were evaluated by HAMD-17 and MDQ scales. Blood samples (n = 100) were collected and extracted for serum followed by detecting serum PER1, PER2 and pCREB levels by ELISA. Results There were 100 participants in the cohort, including 40 in the MDD group, 30 in the BD group and 30 in the health control (HC) group. 71% were female in the cohort. The mean (SD) serum PER1 level in the HC group was 12.05 (2.96) ng/mL, in the MDD group was 8.41 (2.96) ng/mL, significantly decreased vs the HCs, and in the BPD group that was 16.05 (3.60) ng/mL, significantly increased vs the HCs (adjusted P < 0.0001). The serum pCREB level in the HC group was 205.2 (49.57) ng/mL, in the MDD group was 192.6 (38.52) ng/mL, and that in the BPD group was 290.0 (72.10) ng/mL, which was significantly increased vs the HCs and vs the MDD group. For the differential diagnosis between MDD and BPD, PER1 & pCREB (AUC, 0.9858) show similar high diagnostic efficiency as combined biomarkers of PER1, PER2 & pCREB (AUC, 0.9906). Conclusions and relevance This study reveals the importance of serum PER1, combined use of serum PER1 and pCREB as well as that of serum pCREB, PER1 and PER2 in differentiating MDD from BPD. ### Competing Interest Statement The authors have declared no competing interest. ### Funding Statement This work was supported by Natural Science Foundation of China (82071181), Zhejiang Province TCM Modernization Special Project (2020ZX012) to WC, Key Research & Development Program of Zhejiang Province (2020C03021 to WC and 2018C03023 to YDS), Science and Technology Program of Hangzhou Municipality (20212013B02, Z20200051) to YDS, and Natural Science Foundation of China (82201682) to XLW. ### Author Declarations I confirm all relevant ethical guidelines have been followed, and any necessary IRB and/or ethics committee approvals have been obtained. Yes The details of the IRB/oversight body that provided approval or exemption for the research described are given below: This study was approved by the Ethics Committee of Sir Run Run Shaw Hospital, Zhejiang University School of Medicine (No. 20191203-13). All study participants were informed of the purpose and methods of the study, and each participant provided informed consent before enrolment. I confirm that all necessary patient/participant consent has been obtained and the appropriate institutional forms have been archived, and that any patient/participant/sample identifiers included were not known to anyone (e.g., hospital staff, patients or participants themselves) outside the research group so cannot be used to identify individuals. Yes I understand that all clinical trials and any other prospective interventional studies must be registered with an ICMJE-approved registry, such as ClinicalTrials.gov. I confirm that any such study reported in the manuscript has been registered and the trial registration ID is provided (note: if posting a prospective study registered retrospectively, please provide a statement in the trial ID field explaining why the study was not registered in advance). Yes I have followed all appropriate research reporting guidelines, such as any relevant EQUATOR Network research reporting checklist(s) and other pertinent material, if applicable. Yes The original data of this project is available upon reasonable request from the corresponding author, Dr. Wei Chen (srrcw@zju.edu.cn).

BACKGROUND AND AIMS:Smoking is the leading preventable cause of premature death in China, yet less than 10% of smokers seeking to quit receive treatment. This study aimed to test the efficacy of a cognitive behavioral therapy (CBT)-based smoking cessation intervention ('Smokefree Life') via a smartphone app in China. DESIGN:A digital, parallel, single-blind, two-arm (1:1) randomized controlled trial. SETTING:This trial was conducted via 'Smokefree Life' app in the whole of mainland of China between 13 December 2021 and 15 April 2023. PARTICIPANTS:Chinese-speaking adult smokers (925 males, 102 females, mean age 35.0 ± 6.7) willing to quit within one month were recruited via WeChat, survey sampling and referral from doctors, friends and family and randomized in a 1:1 ratio. INTERVENTION:The intervention group (n = 523) received a 13-14 week CBT-based smoking cessation intervention via smartphone app and the control group (n = 504) received only control messages. All participants were followed for 26 weeks post-quit date. MEASUREMENTS:The primary outcome was biochemically validated continuous abstinence at 26 weeks. Secondary outcomes were self-reported 7-day abstinence and continuous abstinence at 26 weeks. FINDINGS:By intention-to-treat analysis, the biochemically verified 26-week continuous abstinence rate was statistically significantly higher in the intervention group (6.50%) compared with the control group (2.58%) (odds ratio = 2.63, 95% confidence interval = 1.40-5.22, P = 0.0037). Self-reported 7-day and continuous abstinence rates were also consistently higher in the intervention group across follow-ups (all P < 0.05). CONCLUSIONS:The 'Smokefree Life' app-based smoking cessation intervention statistically significantly improved 6-month biochemically confirmed quit rates among adult smokers in China.

Insomnia disorder is a significant global health concern. This research aimed to explore the pathogenesis of insomnia disorder using static and dynamic degree centrality methods at the voxel level. A total of 29 patients diagnosed with insomnia disorder and 28 healthy controls were ultimately included to examine differences in degree centrality between the two groups. Additionally, the relationship between altered degree centrality values and various clinical indicators was analyzed. The results revealed that patients with insomnia disorder exhibited higher static degree centrality in brain regions associated with sensory processing, such as the occipital gyrus, inferior temporal gyrus, and supramarginal gyrus. In contrast, lower static degree centrality was observed in the parahippocampal gyrus, amygdala, insula, and thalamus. Changes in dynamic degree centrality were identified in regions including the parahippocampal gyrus, anterior cingulum, medial superior frontal gyrus, inferior parietal gyrus, and precuneus. Notably, a negative correlation was found between dynamic degree centrality in the inferior parietal gyrus and the Pittsburgh Sleep Quality Index, while a positive correlation was observed between static degree centrality in the inferior temporal gyrus and the Hamilton Depression Scale. These findings suggest that dysfunction in centrality within the sensory processing cortex and subcortical nuclei may be associated with the sleep-wake imbalance in individuals with insomnia disorder, contributing to our understanding of hyperarousal mechanisms in insomnia. Moreover, the abnormalities observed in the default mode network and the salience network provide insights into understanding the neuropathogenesis of insomnia from both static and dynamic centrality perspectives. The clinical trial registration number: ChiCTR2200058768. Date: 2022-04-16.

Background:Depression and anxiety are highly prevalent during pregnancy, with psychological interventions being recommended as the first-line treatment. Objective:This study examined the effects of group hypnotic intervention on prenatal depression, anxiety symptoms, and delivery mode. Methods:In a single-center retrospective observational design, 237 pregnant women were included. The intervention group received group hypnotic sessions, while the control group received standard prenatal care. Baseline sociodemographic and clinical characteristics were recorded, including scores on the Hospital Anxiety and Depression Scale (HADS), Hamilton Depression Rating Scale (HAMD), Hamilton Anxiety Rating Scale (HAMA), and heart rate variability (low-frequency/high-frequency ratio [LF/HF]). Measurements were collected at three gestational timepoints (pre-intervention, post-intervention, and 38 weeks' gestation). Between-group and within-group differences in symptom scores and LF/HF were analyzed, and a logistic regression analysis assessed the association between the intervention and the delivery mode. Results:Within-group analyses demonstrated sustained improvement in depression/anxiety symptoms (p < 0.001) and increased LF/HF ratio (p < 0.001) in the intervention group from pre-intervention to 38 weeks' gestation. In contrast, the control group exhibited reduced HADS, HAMD, and HAMA scores at post-intervention (vs. pre-intervention; p = 0.002-0.003), but returned to baseline levels at 38 weeks' gestation (vs. pre-intervention, p = 0.083-0.216). Between-group comparisons revealed significantly greater reductions in HADS, HAMD, and HAMA scores across all time points in the intervention group vs. controls (p < 0.001 for all). Vaginal delivery rates were also significantly higher in the intervention group (p = 0.04). Conclusion:Group hypnotic intervention effectively alleviated prenatal depression and anxiety symptoms and improved vaginal delivery outcomes, suggesting its integration into routine prenatal mental healthcare protocols.

BACKGROUND:Physical activity can alleviate depressive symptoms and has anti-inflammatory effects. However, the extent to which inflammation mediates this relationship is unclear. This study explores the non-linear relationship between the metabolic equivalent of recreational physical activity (MET-RPA), high-sensitivity C-reactive protein (hs-CRP), and depressive symptoms, assessing hs-CRP's mediating role. METHODS:Data from the National Health and Nutrition Examination Survey from 2013 to 2020 were used, including the Patient Health Questionnaire-9 (PHQ-9) scores, hs-CRP, and PA data. Restricted cubic spline models analyzed non-linear relationships, and mediation analysis assessed the mediating role of hs-CRP. RESULTS:MET-RPA exhibited a non-linear "U" shaped relationship with depressive symptoms, where increased MET-RPA initially reduced depressive symptoms risk until a lowest point (3072.96 MET-min/week; i.e., 375 min of vigorous exercise or 750 min of moderate-intensity exercise per week), beyond which the risk increased. A non-linear "L" shaped relationship was observed between MET-RPA and CRP, with a lowest point of 3888.24 MET-min/week. Furthermore, a significant inflexion point was identified at a CRP level of 9.85 mg/L, where depressive symptoms risk increased with rising CRP levels but at a slower rate beyond this point. Mediation analysis revealed that CRP significantly mediated the relationship between MET-RPA and depressive symptoms, accounting for 8.14 % of the total effect. CONCLUSION:Moderate levels of RPA significantly reduce depressive symptoms, while excessive RPA slightly increases the risk of depression. The anti-inflammatory effect of exercise, represented by decreased hs-CRP levels, plays a partial but significant mediating role in the relationship between RPA and depression.